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SUBUNGUAL HEMATOMA
background, S&S, management
SUBUNGUAL HEMATOMA
•Background:
• localized trauma to the toe
•Signs & Symptoms:
• Dark purple nail appearance with pain
•Management:
• Drill the nail to remove the blood, when applicable
1ST MTP JOINT SPRAIN OR TURF TOE
background, management, S&S, special test
Background:
• Sprain of the plantar capsular ligament of the 1st MTP joint
• Usually occur when the foot is planted and the ankle is then dorsiflexed forcing the great toe into hyperextension
• Can also occur from repetitive stress of hyperextension •Signs & Symptoms:
• Pain in the joint during push-off phase of gait and movement, pain with touch, limited ROM
•Management:
• POLICE, Rule out fracture, immobilize if needed, tape to restrict joint from going into hyperextension, shoe with a firm bottom, use of NSAIDs or anti- inflammatory injection
special test: varus/valgus of 1st MTP
METATARSALGIA
background, S&S, management
•Background:
• Excessive pronation may compromise metatarsal head positioning and weight distribution
• Increasing training and/or poor fitting footwear – develop suddenly but most develop over time
•Signs & Symptoms:
• Pain or cramping in metatarsal region, point tenderness, weakness
• Pain is described as sharp, aching, or burning pain – no pain at rest
•Management:
• Pad to elevate metatarsals just behind ball of foot
SESAMOIDITIS
SESAMOIDITIS
•Background:
• Caused by repetitive hyperextension of the great toe resulting in inflammation
•Signs & Symptoms:
• Pain under great toe, especially during push off, Palpable tenderness under first metatarsal head
•Management:
• Treat with orthotic devices, including metatarsal pads, arch supports, & even metatarsal bars
• Decrease activity to allow inflammation to subside
ANKLE SPRAINS—MEDIAL OR EVERSION
ANKLE SPRAINS—MEDIAL OR EVERSION
•Background:
• Forced dorsiflexion and eversion, most are associated with another injury
•Signs & Symptoms:
• Isolated to the medial side, pain with eversion, swelling, PT
•Management:
• Same as lateral ankle sprain
Special Tests:
Eversion (Talar Tilt) Stress Test Kleiger’s Test
ingrown toenail
background, S&S, management
INGROWN TOENAIL
•Background:
• Improper toenail shape, tight fitting shoes, increased friction
•Signs & Symptoms:
• Redness around the nail, pus, pain, swelling
•Management:
• Soak in warm water; Pack the space between the
skin and nail with cotton; “V” cut in the nail; nail
hygiene patient education; tape; possible referral depending on level of infection
PLANTAR FASCIITIS
background, S&S, management, special tests
Background:
• Acute or insidious onset of pain along the plantar aspect of the foot, more often seen in individuals with foot deformity and high impact activities
•Signs & Symptoms:
Pain along the medial calcaneal tubercle that can spread throughout the fascia. Pain increases after sitting for awhile, especially first thing in the morning when stepping out of bed. Barefoot walking increases the pain as well as ascending stairs.
Can rupture immediate difficulty bearing weight and significant pain along with describing a “tear” sensation. Increased swelling and possible discoloration over medical calcaneal tubercle.
•Management:
• RICE, evaluation to determine possible cause and address if possible, referral for possible injection or surgery, orthotics, night splint, tape, increase ankle dorsiflexion, NSAIDs
Special Tests:
• Navicular drop test for pes planus • Windlass test for pes planus
FRACTURES & STRESS FRACTURES OF THE FOOT (TALUS, METATARSALS, JONES)
background, S&S, management, special tests
FRACTURES & STRESS FRACTURES OF THE FOOT (TALUS, METATARSALS, JONES)
•Background:
• 5th metatarsal is the most frequently fractured MT (Jones fracture) • Base of the 5th is prone to avulsion fractures • Stress fractures often result of biomechanical abnormalities of the foot along with overuse
•Signs & Symptoms:
• Fracture = pain and point tenderness over the area of the fracture, swelling and possible ecchymosis, inability to bear weight in some cases, deformity
• Stress fractures = dull pain over the fracture site that increases with activity and decreases with rest
•Management:
• Refer for x-rays, immobilize, rice
•Special Tests:
• Tap test
• Longitudinal compression/distraction
• Transverse compression/distraction
cuboid subluxation syndrome
CUBOID SUBLUXATION SYNDROME
•Background:
• Can result from a twisting of the ankle and/or midfoot which causes the cuboid to move out of place tearing ligaments and leaving it out of place • This can also result from overuse or repetitive strain to your foot. • Excessive foot pronation can also cause condition.
•Signs & Symptoms:
Pain upon standing after a period of NWB or prolonged sitting. Pain increases with walking along the lateral aspect of the foot - fourth and fifth metatarsals as well as the cuboid. Point tender over the cuboid. Pain is relieved immediately after mobilization.
Swelling over the cuboid possible
•Management:
• Rest, ice, immobilize, refer for relocation
high ankle sprain/syndesmosis
ANKLE SPRAINS—SYNDESMOSIS OR “HIGH”
•Background:
• Dorsiflexion and externally rotated talus
•Signs & Symptoms:
• Pain between the distal anterior tibia and fibula, swelling over distal tib-fib
•Management:
• Assess for fx, stabilization for 3-4 weeks, continued bracing, RICE, crutches, may take up to 3 months
•Special Tests:
Kleiger’s Test (external rotation test) Cotton Test (lateral talar glide)
Distal tibiofibular joint play
Squeeze Test
Dorsiflexion Compression Test
HALLUX RIGIDUS AND VALGUS
•Background S&S management
HALLUX RIGIDUS AND VALGUS
•Background:
• Abduction of the 1st ray at the MTP joint and is associated with pes planus foot type
• Also associated with a bunion that forms secondary to the Hallux Valgus
•Signs & Symptoms:
• Pain and dysfunction, can alter biomechanics and cause footwear to fit improperly
•Management:
• Refer if painful, tape or brace to try to restore alignment
heel spur
background, S&S, management
HEEL SPUR
•Background:
• A hook shaped bony outgrowth (exostosis) located on the medial calcaneal tubercle. Incidence increases with age.
•Signs & Symptoms:
• Similar to plantar fascia with a gradual onset
•Management:
• Conservative treatment to decrease pain and
restore function. Surgery possible.
tarsal coalition
background, S&S, management
TARSAL COALITION
•Background:
• Hereditary condition, it is a bony, fibrous, or cartilaginous union between two or more tarsal bones • Often affects the CN, TN, TC joints and 50% of cases occur bilaterally • Becomes symptomatic in pre-teen and teens when the bones begin to ossify. • Usually follows an ankle sprain
•Signs & Symptoms:
• Rigid foot, restricted joint play, results in foot deformities, may have pain over the involved joint
•Management:
• Early intervention of immobilization or use of orthotics
• Surgery is often needed if severe or not caught early
LISFRANC INJURY
LISFRANC INJURY
•Background:
• The dorsal displacement of the proximal end of the MT occurs due to axial load while the foot toes are extended. Can result in sprain, dislocation, or fracture
•Signs & Symptoms:
• May be subtle or obvious, pain & inability to bear weight, swelling, tenderness over the dorsum of the foot
• Often missed!
•Management:
• Referral to physician to restore alignment and stability
• Conservative treatment included prolonged immobilization in
NWB position but surgery is typical for this injury
OSTEOCHONDRAL LESIONS/DEFECTS
OSTEOCHONDRAL LESIONS/DEFECTS
•Background:
• Lesions are small fractures not easily detected by x-rays that can develop into OCD
•Signs & Symptoms:
• Pain “deep” in the ankle, pain along anterior ankle joint
•Management:
• Refer for MRI or CT
bunions/bunionettes
background, S&S, management
BUNIONS AND BUNIONETTES
•Background:
• Formed by the development and subsequent inflammation of a bursa at the 1st MTP joint (bunion) and 5th MTP joint (bunionette or tailor’s bunion)
•Signs & Symptoms:
• Inflammation of the joint, deformity at the joint
•Management:
• POLICE, refer for pain, possible surgery. Tape or brace to decrease pain when possible. Proper fitting footwear.
heel contusion
background, S&S, management
HEEL CONTUSION
•Background:
• Increased force from the ground to the bottom of the heel; misjudging a landing or a drop from a height
•Signs & Symptoms:
• Pain and bruising over the plantar surface of the calcaneus
•Management:
• Ice, immobilize if needed, heel pad
tarsal tunnel
background, S&S, management, special tests
TARSAL TUNNEL SYNDROME (TTS)
•Background:
Caused by the entrapment of the posterior tibial nerve or one of its medial or lateral branches as it passed through the tarsal tunnel
Acute can be caused by trauma, such as tarsal fracture or dislocation, hyperplantarflexion, or eversion.
Overuse can cause TTS, too.
•Signs & Symptoms:
• Diffuse pain, burning, paresthesia, or numbness along the plantar and medical aspect of the foot that increases with activity and decreases with rest.
•Management:
• Conservative at 1st (NSAIDS), orthotics, or possibly surgery
Special Test:
• Tinel’s Sign
• Dorsiflexion-Eversion Test
MIDFOOT SPRAIN
MIDFOOT SPRAIN
•Background:
• Caused by an isolated twisting action, trauma from a fall, or a collision
•Signs & Symptoms:
• Pain in the midfoot that increases with standing or walking, may see swelling and/or ecchymosis
•Management:
• X-ray to rule out fracture, MRI to detect ligamentous involvement; immobilize and/or protect the structure
CHRONIC ANKLE INSTABILITY
CHRONIC ANKLE INSTABILITY
•Background:
• Characterized by a recurring giving way of the outer (lateral) side of the ankle that develops after repeated ankle sprains.
•Signs & Symptoms:
• “Giving way” can occur during activity or while standing still, persistent discomfort and swelling, pain and tenderness, instability of the ankle joint
•Management:
• Rehab to restore strength, ROM, and function
• Bracing to increase stability
• NSAIDs
• Surgery, if stability cannot be restored
phalangeal fractures and disocations
background, S&S, management
FRACTURES & DISLOCATIONS OF THE PHALANGES
•Background:
• Longitudinal force applied to the bone or crush injury
•Signs & Symptoms:
• Deformity, pain, swelling, crepitus
•Management:
• Ice, immobilize, refer
longitudinal arch sprain
background, S&S, management
LONGITUDINAL ARCH STRAIN
•Background:
• Calcaneonavicular ligament – “spring ligament” – supports medial arch
• Increased stress on arch
• May be associated with sprained calcaneonavicular ligament & flexor hallucis longus strain
•Signs & Symptoms:
• Pain with running & jumping, usually below posterior tibialis tendon, accompanied by pain & swelling
•Management:
• RICE, reduction of weight bearing if too painful to bear weight, arch taping
MORTON’S NEUROMA
background, S&S, management, special tests
MORTON’S NEUROMA
•Background:
• It is a benign growth of nerve tissue and swelling that is caused by trauma or repeated stress caused by tight fitting shoes or a pronated foot which leads to pressure on the plantar digital nerves as they are compressed between the MT heads. 3rd and 4th or 2nd and 3rd.
•Signs & Symptoms:
• Feels like on a “pebble”, tingling & burning, radiates to the toes, sharp, shock-like sensation.
•Management:
• MT pad, shoe selection, corticosteroid injections or surgery
Special Tests:
• Pencil test
• Mulder sign for intermetatarsal neuroma • Interdigital neuroma test
ANKLE SPRAINS—LATERAL OR INVERSION
ANKLE SPRAINS—LATERAL OR INVERSION
•Background:
• Result of a plantarflexion and inversion force • Open-packed vs. closed-packed position
• Grades 1-3
•Signs & Symptoms:
• “Cracking sensation”, possibly unable to bear weight, swelling, tenderness, bony tenderness, ecchymosis, patient reports hearing a “pop”
•Management:
• Assess for a fracture, RICE, horseshoe pad, possible crutches & referral
Special Tests:
Anterior Drawer Test
Inversion (Talar Tilt) Stress Test Medial Subtalar Joint Play
ankle fracture
ANKLE FRACTURE
•Background:
• Caused by a rotational force when the ankle is twisted or high-force impact
•Signs & Symptoms:
• Pain, swelling, deformity
•Management:
• Immobilize and refer
•Special Tests:
• Ottawa Ankle Rules
• Squeeze/Compression Test
• Bump Test
• Tap/Percussion
• Tuning Fork – Auscultation Test